| NPI | 1629230750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA K. WATT Vice President 307-672-2421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1097) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 814) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-06-30 |